Effect of Rhythmic Auditory Cueing on Aging Gait: A Systematic Review and Meta-Analysis

Shashank Ghai, Ishan Ghai, Alfred O Effenberg, Shashank Ghai, Ishan Ghai, Alfred O Effenberg

Abstract

Rhythmic auditory cueing has been widely used in gait rehabilitation over the past decade. The entrainment effect has been suggested to introduce neurophysiological changes, alleviate auditory-motor coupling and reduce cognitive-motor interferences. However, a consensus as to its influence over aging gait is still warranted. A systematic review and meta-analysis was carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal gait parameters among healthy young and elderly participants. This systematic identification of published literature was performed according to PRISMA guidelines, from inception until May 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Of 2789 records, 34 studies, involving 854 (499 young/355 elderly) participants met our inclusion criteria. The meta-analysis revealed enhancements in spatiotemporal parameters of gait i.e. gait velocity (Hedge's g: 0.85), stride length (0.61), and cadence (1.1), amongst both age groups. This review, for the first time, evaluates the effects of auditory entrainment on aging gait and discusses its implications under higher and lower information processing constraints. Clinical implications are discussed with respect to applications of auditory entrainment in rehabilitation settings.

Keywords: balance; cognitive-motor interference; cueing; dual task; entrainment; rehabilitation; stability.

Conflict of interest statement

Competing Financial Interests No financial interests are declared. Supplemental data Supplemental data are available online.

Figures

Figure 1.
Figure 1.
PRISMA flow chart for the inclusion of studies.
Figure 2.. Funnel plot for Hedge’s g…
Figure 2.. Funnel plot for Hedge’s g & standardized effect for each effect in the meta-analysis
Each of the effect is represented in the plot as a circle. Funnel boundaries represent area where 95% of the effects are expected to abstain if there were no publication bias. The vertical line represents mean standardized effect of zero. Absence of publication bias is represented when the effects should be equally dispersed on either side of the line.
Figure 3.
Figure 3.
Risk of bias across studies.
Figure 4.. Forest plot illustrating individual studies…
Figure 4.. Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on gait velocity among healthy young and elderly participants
A negative effect size indicated reduction in gait velocity; a positive effect size indicated enhancement in gait velocity. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative mean difference indicates a favorable outcome for control groups; a positive mean difference indicates a favorable outcome for experimental groups. (O: Old, Y: Young, FP: Fast paced, SP: Slow paced, DT: Dual-task, I: Isosynchronous, B: Biological variability, LG: Low groove, HG: High groove, INS: Instructions, Mt: Motivating feedback, NMt: Non-motivating feedback).
Figure 5.. Forest plot illustrating individual studies…
Figure 5.. Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on stride length among healthy young and elderly participants
A negative effect size indicated reduction in stride length; a positive effect size indicated enhancement in stride length. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative mean difference indicates a favorable outcome for control groups; a positive mean difference indicates a favorable outcome for experimental groups. (O: Old, Y: Young, FP: Fast paced, SP: Slow paced, DT: Dual-task, I: Isosynchronous, B: Biological variability, LG: Low groove, HG: High groove, INS: Instructions, Mt: Motivating feedback, NMt: Non-motivating feedback).
Figure 6.. Forest plot illustrating individual studies…
Figure 6.. Forest plot illustrating individual studies evaluating the effects of rhythmic auditory cueing on cadence among healthy young and elderly participants
A negative effect size indicated reduction in step frequency; a positive effect size indicated enhancement in step frequency. Weighted effect sizes; Hedge’s g (boxes) and 95% C.I (whiskers) are presented, demonstrating repositioning errors for individual studies. The (Diamond) represents pooled effect sizes and 95% CI. A negative mean difference indicates a favorable outcome for control groups; a positive mean difference indicates a favorable outcome for experimental groups. (O: Old, Y: Young, FP: Fast paced, SP: Slow paced, DT: Dual-task, I: Isosynchronous, B: Biological variability, LG: Low groove, HG: High groove, INS: Instructions, Mt: Motivating feedback, NMt: Non-motivating feedback)

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